Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease: An International Ventricular Tachycardia Ablation Center Collaborative Study

Marmar Vaseghi; Tiffany Y. Hu; Roderick Tung; Pasquale Vergara; David S. Frankel; Luigi Di Biase; Usha B. Tedrow; Jeffrey A. Gornbein; Ricky Yu; Nilesh Mathuria; Shiro Nakahara; Wendy S. Tzou; William H. Sauer; J. David Burkhardt; Venkatakrishna N. Tholakanahalli; Timm-Michael Dickfeld; J. Peter Weiss; T. Jared Bunch; Madhu Reddy; David J. Callans; Dhanunjaya R. Lakkireddy; Andrea Natale; Francis E. Marchlinski; William G. Stevenson; Paolo Della Bella; Kalyanam Shivkumar

doi:10.1016/j.jacep.2018.05.007

JACC: Clinical Electrophysiology

Volume 4, Issue 9, September 2018 DOI: 10.1016/j.jacep.2018.05.007

Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease
An International Ventricular Tachycardia Ablation Center Collaborative Study

Marmar Vaseghi, Tiffany Y. Hu, Roderick Tung, Pasquale Vergara, David S. Frankel, Luigi Di Biase, Usha B. Tedrow, Jeffrey A. Gornbein, Ricky Yu, Nilesh Mathuria, Shiro Nakahara, Wendy S. Tzou, William H. Sauer, J. David Burkhardt, Venkatakrishna N. Tholakanahalli, Timm-Michael Dickfeld, J. Peter Weiss, T. Jared Bunch, Madhu Reddy, David J. Callans, Dhanunjaya R. Lakkireddy, Andrea Natale, Francis E. Marchlinski, William G. Stevenson, Paolo Della Bella and Kalyanam Shivkumar

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Author + information

vol. 4 no. 9 1141-1150

DOI:

https://doi.org/10.1016/j.jacep.2018.05.007

Published By:

JACC: Clinical Electrophysiology

Print ISSN:

2405-5018

Online ISSN:

2405-500X

History:

Received March 2, 2018
Revision received May 2, 2018
Accepted May 15, 2018
Published online September 17, 2018.

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2018 American College of Cardiology Foundation

Author Information

Marmar Vaseghi, MD, PhD^a,^∗^∗ (mvaseghi{at}mednet.ucla.edu),
Tiffany Y. Hu, MD^a,^∗,
Roderick Tung, MD^b,
Pasquale Vergara, MD, PhD^c,
David S. Frankel, MD^d,
Luigi Di Biase, MD, PhD^e,
Usha B. Tedrow, MD^f,
Jeffrey A. Gornbein, DrPH^g,
Ricky Yu, MD^a,
Nilesh Mathuria, MD^h,
Shiro Nakahara, MD, PhDⁱ,
Wendy S. Tzou, MD^j,
William H. Sauer, MD^j,
J. David Burkhardt, MD^k,
Venkatakrishna N. Tholakanahalli, MD^l,
Timm-Michael Dickfeld, MD, PhD^m,
J. Peter Weiss, MD, MScⁿ,
T. Jared Bunch, MDⁿ,
Madhu Reddy, MD^o,
David J. Callans, MD^d,
Dhanunjaya R. Lakkireddy, MD^p,
Andrea Natale, MD^k,
Francis E. Marchlinski, MD^d,
William G. Stevenson, MD^q,
Paolo Della Bella, MD^c and
Kalyanam Shivkumar, MD, PhD^a

^aUCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
^bUniversity of Chicago, Chicago, Illinois
^cHospital San Raffaele, Milan, Italy
^dHospital of the University of Pennsylvania; Philadelphia, Pennsylvania
^eAlbert Einstein College of Medicine at Montefiore Hospital, Bronx, New York
^fBrigham and Women’s Hospital, Boston, Massachusetts
^gDepartment of Biostatistics, University of California, Los Angeles, Los Angeles, California
^hBaylor St. Luke’s Medical Center/Texas Heart Institute, Houston, Texas
ⁱDokkyo Medical University Koshigaya Hospital, Saitama, Japan
^jUniversity of Colorado, Aurora, Colorado
^kTexas Cardiac Arrhythmia Institute, St. David’s Medical Center; Austin, Texas
^lUniversity of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
^mUniversity of Maryland Medical Center, Baltimore, Maryland
ⁿIntermountain Heart Institute, Intermountain Medical Center, Murray, Utah
^oUniversity of Kansas Medical Center, Kansas City, Kansas
^pOverland Park Regional Medical Center, HCA Midwest Health, Overland Park, Kansas City, Kansas
^qVanderbilt University, Nashville, Tennessee

↵∗Address for correspondence:
Dr. Marmar Vaseghi, UCLA Cardiac Arrhythmia Center, 100 Medical Plaza, Suite 660, Los Angeles, California 90095.

Graphical abstract

Abstract

Objectives This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates.

Background Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM.

Methods Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders.

Results Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence.

Conclusions Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.

Key Words

Footnotes

↵∗ Drs. Vaseghi and Hu contributed equally to this work and are joint first authors. Katia Zeppenfeld, MD, served as Guest Editor for this paper.
The study was an unfunded, investigator-initiated collaborative study. Dr. Vaseghi is supported by National Institutes of Health Grant No. DP2 DP2HL132356-01 and Dr. Shivkumar is supported by National Institutes of Health Grant No. OT2OD023848. Dr. Di Biase has served as a consultant for Stereotaxis, Boston Scientific, Abbott, and Biosense Webster; and has received speaker/travel honoraria from Medtronic, Atricure, Pfizer, EpiEP, and Biotronik. Dr. Tedrow has received honoraria from Medtronic, St. Jude Medical, and Boston Scientific; and research grant support from Biosense Webster and St. Jude Medical. Dr. Tzou has received speaker honoraria from Medtronic, Boston Scientific, and Biosense Webster; and has served as a consultant for Biosense Webster and Abbott. Dr. Burkhardt has received honoraria from Biosense Webster. Dr. Tholakanahalli has received research grant support from and owns intellectual property rights at St. Jude Medical. Dr. Dickfeld has received honoraria from Biosense Webster, Siemens, St. Jude Medical, Abbott Laboratories, and Impulse Dynamics USA; and research grant from GE Healthcare and Biosense Webster. Dr. Weiss has received consulting honoraria from Stereotaxis. Dr. Bunch has received honoraria from Boston Scientific. Dr. Reddy has received speakers’ honoraria from Pfizer, Zoll, Janssen, and BMS. Dr. Callans has received honoraria from Biosense Webster, Medtronic, and St. Jude Medical. Dr. Natale has served as a consultant for Biosense Webster, Stereotaxis, Abbott, and Boston Scientific; and has received speaker/travel honoraria from Medtronic, Atricure, Biotronik, and Janssen. Dr. Stevenson has received speakers’ honoria from Abbott Medical and Boston Scientific; and is co-holder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital and co-held with Biosense Webster. Dr. Della Bella has received research grant support from Biosense Webster; and has served as a consultant for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.

Received March 2, 2018.
Revision received May 2, 2018.
Accepted May 15, 2018.

2018 American College of Cardiology Foundation

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